Penile metastasis from prostate adenocarcinoma: A case report and review of the literature.

Penile metastasis from prostate adenocarcinoma is an exceptionally rare clinical finding, occurring in <0.3% of cases. We report an 85-year-old male with a history of Gleason 4+3 acinar adenocarcinoma, managed conservatively with long-term bicalutamide monotherapy because of his clinical stability. Eight years after diagnosis, he developed a painful, ulcerated glans lesion, surgically excised via glansectomy. Histopathology revealed solid adenocarcinoma with angiolymphatic invasion, high Ki-67 index (20-70%), PSA and CDX2 positivity, and negative CK7/CK20/TTF-1/p63 staining, confirming prostatic origin. Despite the presence of metastasis, disease progression remained indolent, supporting the feasibility of individualized, conservative therapy in selected elderly patients. Literature review highlights venous or lymphatic spread as probable pathways, with prognosis varying widely. This case underscores the importance of considering secondary malignancy in penile lesions, utilizing histopathology and immunohistochemistry for definitive diagnosis, and tailoring management to patient comorbidities and preferences to preserve quality of life.